Division of Behavioral Health Services

Definitions

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BHS Definitions ListPDF (revised 07/14/14)

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A

Abuse

The infliction of, or allowing another person to inflict or cause physical pain or injury, impairment of bodily function, disfigurement or serious emotional damage which may be evidenced by severe anxiety, depression, withdrawal or untoward aggressive behavior. Such abuse may be caused by acts or omissions of an individual having responsibility for the care, custody or control of a client receiving behavioral health services or community services. Abuse shall also include sexual misconduct, assault, molestation, incest, or prostitution of, or with, a client under the care of personnel of a mental health agency, which may occur under circumstances outside of a licensed sponsored activity.

Abuse (of child/minor)

The infliction or allowing of physical injury, impairment of bodily function or disfigurement or the infliction of or allowing another person to cause serious emotional damage as evidenced by severe anxiety, depression, withdrawal or untoward aggressive behavior and which emotional damage is diagnosed by a medical doctor or psychologist pursuant to section A.R.S. § 8-821 and is caused by the acts or omissions of an individual having care, custody and control of a child. Abuse includes:

  1. Inflicting or allowing sexual abuse pursuant to section A.R.S. § 13-1404, sexual conduct with a minor pursuant to section A.R.S. § 13-1405, sexual assault pursuant to section A.R.S. § 13-1406, molestation of a child pursuant to section A.R.S. § 13-1410, commercial sexual exploitation of a minor pursuant to section A.R.S. § 13-3552, sexual exploitation of a minor pursuant to section A.R.S. § 13-3553, incest pursuant to section A.R.S. § 13-3608 or child prostitution pursuant to section A.R.S. § 13-3212.
  2. Physical injury to a child that results from abuse as described in section A.R.S. § 13-3623, subsection C.

Abuse (of incapacitated or vulnerable adult)

  1. Intentional infliction of physical harm.
  2. Injury caused by negligent acts or omissions.
  3. Unreasonable confinement.
  4. Sexual abuse or sexual assault.

Abuse Section 5.3

For purposes of this section 5.3, includes both physical and sexual abuse

Abuse Section 7.1

Provider practices that are inconsistent with sound fiscal business, or medical practices, and result in an unnecessary cost to the AHCCCS program, the State of Arizona or in reimbursement for services that are not medically necessary or that fail to meet professionally recognized standards for health care. It also includes behavioral health recipient practices that result in unnecessary costs to the AHCCCS program and/or the State of Arizona

Abuse Section 7.4

The infliction of, or allowing another person to inflict or cause physical pain or injury, impairment of bodily function, disfigurement or serious emotional damage which may be evidenced by severe anxiety, depression, withdrawal or untoward aggressive behavior. Such abuse may be caused by acts or omissions of an individual having responsibility for the care, custody or control of a client receiving behavioral health services or community services. Abuse shall also include sexual misconduct, assault, molestation, incest, or prostitution of, or with, a client under the care of personnel of a mental health agency, which may occur under circumstances outside of a licensed sponsored activity.

Action

The denial or limited authorization of a requested service, including the type or level of service;

  • The reduction, suspension or termination of a previously authorized service;
  • The denial, in whole or in part, of payment of service;
  • The failure to provide covered services in a timely manner;
  • The failure to act within established timeframes for resolving an appeal or complaint and providing notice to affected parties; and
  • The denial of the Title XIX/XXI eligible person's request to obtain covered services outside the network.

Acute Health Plan and Provider Coordinator

A person or persons identified by the T/RBHA to act as a single point of contact to respond to coordination of care inquiries from AHCCCS Health Plans, PCP's and other involved clinicians. This coordinator will be supervised by and have direct priority access to a Behavioral Health Professional (BHP) as described in R9-20-204 and performs the functions as described in the ADHS/RBHA Contracts and ADHS/Tribal IGA's.

ADHS/DBHS Documents

Include contracts, policies, plans, manuals, and clinical guidance documents that collectively describe all behavioral health system requirements and expectations.

ADHS/DBHS Medical Policies

Describe required clinical and medical functions pertaining to the direct provision of behavioral health services. The ADHS/DBHS Medical Director designates and signs all policies contained in DBHS Policy and Procedures Manual.

ADHS/DBHS Medication List

A list of minimum medications covered for Title XIX/XXI and Non-Title XIX/XXI eligible persons that must be included on each T/RBHA formulary.

ADHS/ DBHS Office of Grievance and Appeals

The Office of Grievance and Appeals is responsible for the administration and oversight of the administrative grievance and appeal processes. In addition, the Office of Grievance and Appeals investigates allegations of sexual abuse, physical abuse or the death of individuals determined to have a Serious Mental Illness (SMI). The purpose of the grievance and appeal processes is to resolve case specific issues and to remedy any systematic concerns that are identified.

ADHS/DBHS Office of Human Rights

The Office of Human Rights (OHR), established within ADHS/DBHS, is responsible for assisting individuals who have been determined to have a Serious Mental Illness (SMI) with understanding, exercising and protecting their rights through outreach and education, addressing systemic issues and direct advocacy assistance. OHR advocates assist individuals, primarily individuals in need of Special Assistance, with individual service planning and inpatient treatment/discharge planning and the grievance/investigation and appeal processes. The Office of Human Rights is also responsible for providing general oversight, addressing systemic issues and maintaining a list of all individuals in need of Special Assistance to help ensure that their needs are met.

ADHS/DBHS Policy Committee

Is the body responsible for the review and development of ADHS/DBHS policy. The ADHS/DBHS Policy Committee includes, at a minimum, ADHS/DBHS division and office representatives, family members, peers and other representatives as necessary.

ADHS/DBHS Policy Comment

Means a stage of draft (ADHS/DBHS) documents whereby suggestions for revisions are elicited from providers, behavioral health recipients, family members, state agencies and other stakeholders. ADHS/DBHS considers suggested revisions collected during the public comment stage when finalizing ADHS/DBHS documents.

Addiction

Compulsion and craving to use alcohol or other drugs regardless of negative or adverse consequences.

Adjudication Hearing

In juvenile proceedings - during a fact finding session, the court determines whether or not there is sufficient evidence to sustain the allegations found in a petition. An adjudication hearing is the juvenile counterpart to an adult trial.

Administrative Appeal

An appeal to the ADHS/DBHS of a decision made by the Arizona State Hospital or a T/RBHA as the result of a grievance.

Administrative Hearing

A hearing conducted by the Office of Administrative Hearings under A.R.S. Title 41, Chapter 6, Article 10.

Administrative Review

The portion of the appeal process beginning with the initial filing of a formal written appeal by the provider with the TRBHA or ADHS/DBHS and concluding with the issuance of a final decision by a RBHA or ADHS/DBHS that advises of formal hearing rights under A.R.S 41-1092 et seq.

Adult Recovery Team

A group of individuals, that following the nine Guiding Principles for Recovery-Oriented Adult Behavioral Health Services and Systems, work in collaboration and are actively involved in a person's assessment, service planning and service delivery. At a minimum, the team consists of the person, his/her guardian (if applicable), advocates (if assigned), and a qualified behavioral health representative. The team may also include members of the enrolled person's family, physical health, mental health or social service providers, representatives or other agencies serving the person, professionals representing various areas of expertise related to the person's needs, designated representatives or other persons identified by the enrolled person.

Advance Directive

Federal regulations define an advance directive as a written instruction, such as a living will or durable power of attorney for health care, recognized under State law (whether statutory or as recognized by the courts of the State), relating to the provision of health care when the individual is incapacitated.

Adverse Action or Decision

For purposes of this section means an action or decision taken by a T/RBHA or ADHS/DBHS for which a provider may file an appeal. This does not include disputes between a prospective service provider and a T/RBHA in connection to the T/RBHA's contract process.

Adverse Drug Event (ADE)

Any incident in which the use of a medication (drug or biologic) at any dose, a medical device, or a special nutritional product (for example, dietary supplement, infant formula, medical food) may have resulted in an adverse outcome in a consumer.

Adverse Drug Reaction (ADR)

An undesirable response associated with use of a drug that either compromises therapeutic efficacy, enhances toxicity, or both.

Age Groups: The following age groups have been defined to provide consistency to data field requirements.

  • 0 thru 4 - Birth through age 4 but not equal to age 5.
  • 5 thru 17 - Age 5 thru age 17 but not equal to age 18.
  • 0 thru 17 - Birth through age 17 but not equal to age 18.
  • 5 & Older - Age 5 and older.
  • 18 & Older - Age 18 and older.

AHCCCS Adult Group

Includes adults in the AHCCCS Care Program. The Adult Group also includes persons who are 19-64 year old who 1) have incomes between 100-133% of the federal poverty guidelines and 2) are not pregnant and 3) do not have Medicare.

AHCCCS Care Program (Childless Adults)

Eligible individuals and childless adults whose income is less than or equal to 100% of the FPL, and who are not categorically linked to another Title XIX program. Also known as Childless Adults (Formerly Non-MED). See also "Title XIX WAIVER GROUP MEMBER. (See AHCCCS/ADHS Contract from October 2013.)

Alcohol and Drug Abuse Program

(42 CFR Part 2) An individual or entity (other than a general medical care facility) who holds itself out as providing, and provides, alcohol or drug abuse diagnosis, treatment or referral for treatment;

An identified unit within a general medical facility, which holds itself out as providing, and provides, alcohol or drug abuse diagnosis, treatment or referral to treatment;

Medical personnel or other staff in a general medical care facility whose primary function is the provision of alcohol or drug abuse diagnosis, treatment or referral for treatment and who are identified as such providers.

Alcohol and/or Drug Services, Intensive Outpatient Program (IOP)

Treatment program that operates at least 3 hours/day and at least 3 days/week and is based on an individualized treatment plan, including assessment, counseling, crisis intervention and activity therapies or education.

American Indian Tribal Member

Any individual defined in 25UC16039(c)[IHCIA, Sec 4(13)], 1603(f) [IHCIA Sec. 4(28)] or 1679(b) [IHCIA Sec. 809(a)], or who has been determined eligible as an Indian pursuant to Section 136.12 of this part. This means the individual is:

  1. A member of a Federally-recognized Indian tribe;
  2. Resides in an urban center and meets one or more of the following four criteria:
    1. Is a member of a tribe, band or organized group of Indians, including those tribes, bands or groups terminated since 1940 and those recognized now or in the future by the State in which they reside, or who is a descendant, the first or second degree, of any such member;
    2. Is an Eskimo of Aleut or other Alaska Native;
    3. Is considered by the Secretary of the Interior to be an Indian for any purpose; or
    4. Is determined to be an Indian under regulations promulgated by the Secretary;
  3. Is considered by the Secretary of the Interior to be an Indian for any purpose; or;
  4. Is considered by the Secretary of Health and Human Services to be an Indian for purposes of eligibility for Indian Health care services, including as a California Indian, Eskimo, Aleut or other Alaska Native.

Annual Update

An annual review and documented update of a person's behavioral health assessment, treatment and progress toward meeting defined service goals over the past year. In addition to meeting with the person and other team members this involves a review of the person's behavioral health record including previous assessments, progress notes, medications, service plans and reviews, and demographic and clinical data elements for the past 12 months.

Appeal ASH

A request for review of an action. For purposes of this section, a request for review of a decision made by ADHS/DBHS, ASH, a T/RBHA or a T/RBHA provider.

Appeal Resolution

For purposes of this policy is the written determination by the RBHA or ADHS/DBHS, or ASH concerning an appeal.

Appeal Section 5.2/GA 3.1

A request for review of an action, and for a person determined to have a serious mental illness, an adverse decision by a T/RBHA or ADHS/DBHS.

Appeal Section 5.1/GA 3.3

A request for review of an action.

Appeal Section 5.5/Appeal GA 3.5

For purposes of this section, a request for review of a decision made by ADHS/DBHS, a T/RBHA or a T/RBHA provider.

Appealable Agency Action

An action that determines the legal rights, duties, or privileges of a party.

Applicant

For purposes of this policy, includes an agency that has submitted an application for Title XIX Certification as a Community Service Agency.

Approval

The process by which ADHS/DBHS allows the use of a new technology or change in use of an existing technology.

Arizona Department of Housing (ADOH)

A department established for state government in Arizona to assist in addressing needs for homes for working families. In an effort to allow for greater coordination and innovation of housing related services at the state level, the Legislature passed and Governor Jane Dee Hull signed HB2615 during the 2001 legislative session, establishing the Arizona Department of Housing (ADOH). The functions of this department were previously performed by the Arizona Department of Commerce.

Assessment

The initial and ongoing collection and strengths-based analysis of a person's current and historical medical, psychological, psychiatric, developmental, and social conditions in order to determine if a behavioral health disorder exists, if there is a need for behavioral health services, and to ensure that the person's service plan is designed to meet the person's (and family's) current needs and long-term recovery goals.

Attachment (relationship)

An enduring emotional connection between a caregiver and an infant/young child. Attachment is characterized by the child's tendency, when under stress, to seek contact, comfort and proximity to a specific individual ("attachment figure") who is perceived to be bigger, stronger, wiser, and more competent. If that person is available to the child for comfort or protection, s/he will be preferred over any other individual. Conditions which typically activate children's behavior for seeking comfort and security are fatigue, illness, fear, and other experiences of vulnerability. Infants are not born attached to anyone and early on respond to the various people they encounter in very similar (though not identical) ways. Over the course of the first year of life however, infants become increasingly selective about whom they regard as competent to protect and comfort them. The emergence of a discriminate attachment figure, an attachment to a specific other, typically occurs in the 7-9 month period of development, cross-culturally. Given the opportunity, infants typically form attachments to more than one person.

Attachment Behavior

Any form of behavior that results in a person attaining or retaining proximity to a specific and preferred individual for the purpose of achieving protection, comfort, and/or the feeling of security. A young child's attachment behaviors include crying, smiling, calling, reaching, following, clinging, and protesting separations from attachment figures, the condition of being alone, or placement with a stranger. Attachment behaviors are designed to activate the caregiver's corresponding inclination to meet the child's need for protection, comfort, and/or the feeling of security.